Cascade of care, awareness and treatment of Chronic Hepatitis B in Malaysia- findings from a community-based screening campaign

Abstract

Introduction In 2016 the World Health Organization (WHO) had adopted a global strategy to eliminate Hepatitis B (HBV) by 2030 through five core interventions, the first four were preventive while the fifth is the cascade of care, the continuum of services that persons with chronic HBV should receive as they progress from screening to diagnosis to treatment to chronic care. We determined the prevalence of the awareness and treatment of chronic HBV in Malaysia based on a large sample data from a screening campaign. Methods A total of 10,436 subjects participated in the HBV screening campaign organized by the Hepatitis Free Pahang Malaysia (HFPM) in 2018 and 2019. All screen-positive subjects were recalled to undergo laboratory-based HBsAg and HBV DNA tests. Patients with confirmed chronic HBV were referred to local health services, while continued being monitored by HFPM. Results We estimated 13.1% of Malaysian adults aged 20 or older with chronic HBV were aware of their HBV status, and of those only 0.7% had received prior anti-viral treatment, but among those with baseline HBV DNA level>20,000 IU/ml, 15.6% were subsequently treated. Tenofovir disoproxil fumarate was the only medicine used on all treated patients. The linkage to care post-screening was broken in substantial number of patients, only 108 (54%) subjects had returned to have their HBV DNA measured and only 115 (58%) patients had subsequently sought care and were on still follow-up. Conclusion Few Malaysian adults with HBV were aware of their infection and even less received anti-viral therapy. Concerted public health efforts are urgently needed to improve HBV screening and care cascade in order to meet WHO targets for HBV elimination. Keywords Cascade of care, Awareness, Treatment, Hepatitis B, Malaysia